President Trump’s immigration plan could hurt elderly and disabled the most

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She runs the Bethany Health Care Center in Framingham, Massachusetts, and depends on new arrivals from Haiti, El Salvador, Guatemala and other countries to take care of the elderly residents. At least 60% of her staff are immigrants, and she’s having trouble finding folks to fill the more than 20 open positions she has at the long-term care facility and home health care agency.

“For me, I would be lost without the immigrants,” McCarthy said, noting there are more than 2,700 unfilled slots for certified nursing assistants in the state. “They are the backbone of my staffing. We could service many more people, but we can’t recruit the staff.”

Immigrants account for more than one-quarter of workers who directly care for the elderly and disabled, including nursing home aides, home health aides and personal care attendants, as well as 30.3% of housekeeping and maintenance workers in nursing homes, according to a recent Harvard University study published in Health Affairs. They provide paid, hands-on care for more than 13 million Americans.
The administration has repeatedly urged Congress to shift the nation’s immigration policy to one based on merit, instead of family ties. Such a system would prioritize high-skilled workers, which advocates argue would reduce immigration rates and minimize newcomers’ reliance on public assistance.

Such a move, however, will exacerbate the employee shortages that already exist and are expected to grow even more dire as America ages, industry experts say.

“We are going to need immigrants. Whether or not we have the channel of such workers to come into home care is a big question,” said William Dombi, president of the National Association of Home Care & Hospice, which represents about 2,700 agencies.

His group has not been able to land a meeting with Trump administration officials, though it does talk to congressional staffers, he said.

Home health aides and personal care aides are projected to be among the fastest growing jobs between 2016 and 2026, according to the Bureau of Labor Statistics, even though they are also the lowest paid on the list, earning typically $24,000 a year.

The good economy and tight labor market are making it harder to recruit and hold onto staff since they have more job options, said Phil Bongiorno, executive director of the Home Care Association of America, which represents agencies that provide personal care aides. Anything that limits the influx of potential staff will only make it more competitive, he said.

The need for home health and personal care aides, as well as nursing home workers, is expected to grow substantially since the size of the elderly population is projected to nearly double by 2050, said Leah Zallman, co-author of the Harvard study and a primary care physician with Cambridge Health Alliance, a safety net health care system in Massachusetts.

“The series of policies that Trump is proposing to reduce the flow of low-skilled labor in this country is exactly at odds with our demographic shift,” she said. “We just don’t have the young, working-age population that we need to care for elders. These policies are going to leave millions of elderly and disabled stranded without care.”

The American Health Care Association, which represents more than 13,700 not-for-profit nursing homes and long-term care centers, is advocating for legislation to raise the current caps on the number of immigrants that can come to the US — and not just for high-skilled professionals, such as engineers and data scientists, said Clif Porter, the group’s senior vice president for government relations.

“Clearly, there’s a role for what I would call lower-tech workers,” Porter said. “Any policy, frankly, that encourages lifting those caps will go a long, long way in helping us fulfill the needs we have in our sector.”

Overall, though, he finds it can be an uphill battle with policymakers.

“There has been a lack of recognition that we have an explosive, tidal wave influx of elders and folks who are going to need hands-on care,” he said. “There’s not been a significant amount of thoughtful policy that essentially increases the kinds of workers that we need.”

Also, many immigrants in entry-level health care jobs work their way up into more skilled positions, McCarthy said.

“When people come here, they start out in maybe the laundry and housekeeping. But while they’re here, they are going to school,” she said. “They become CNA’s [certified nursing assistants] and then nurses. That’s how it usually rolls for us.”

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